Treating Anorexia as a Process of Reprogramming

Anorexia is one of the most intransigent psychiatric illnesses to treat, certainly much harder than any other eating disorder.

In this blog, I have written extensively about the eating disorder thought process of anorexia. People often experience it as screaming in their head, almost a person’s voice telling them what to do. The more they disobey these thoughts, the louder the screams get.

These are not psychotic symptoms which entail people hearing or seeing things that aren’t there. These voices are thoughts in one’s mind, disembodied thoughts that don’t fully seem like one’s own individual thoughts.

The person with anorexia often feels taken over by the thoughts to the point that their own thoughts and feelings are pushed aside and replaced by the eating disorder. One’s personality, wishes and feelings all become secondary to the demands of the eating disorder thoughts.

Successful therapy for severe anorexia can often feel like reprogramming: a process of unearthing the person’s true thoughts and feelings after years of being buried under the illness. The treatment involves creating a strong bond between the therapist and actual person to help the person to question the eating disorder thoughts and motives.

Once the person begins to question the thoughts, it leads to the possibility of considering others options. Is being so starved actually something that improves one’s life? Does it feel good to be sick and weak? Is being underweight a true accomplishment? Why is it worth forgoing everything else in life that matters? Isn’t it better to have real relationships than only a relationship with your eating disorder?

These questions are a start, but even when the person can see the contradictions, questioning the anorexia still feels like betraying these thoughts that have protected the person, kept her safe and made sure she felt ok. The step towards reframing this concept of betrayal as a process of moving forward in one’s life is equally critical.

It is almost as if recovery from anorexia is a reprogramming after being brainwashed by this illness. I can’t think of another Illness that coopts brain function yet still leaves the rest of one’s abilities intact.

The next post will address a secondary effect of anorexia. Namely, how does the concept of anorexia as brainwashing open the door to the cult of the brilliant clinician?